№ 7 (2025)

The objective of the review was to systematize the literature data on the impact of abortions on women’s health. The paper provides the conclusions that abortions have many negative effects; they cause both early and long-term complications, increasing the risks of gynecological and somatic diseases, obstetric and perinatal complications in subsequent pregnancies. Early pregnancy complications include bleeding, uterine perforation, amniotic fluid embolism, thromboembolic, infectious and inflammatory complications. The long-term consequences of abortions refer to gynecological diseases, infertility, obstetric complications in subsequent pregnancies (gestational diabetes, placenta previa, cervical incompetence, premature birth, bleeding, low birth weight), oncological and cardiovascular diseases, and mental health disorders. Measures aimed at preventing abortions and supporting women in their reproductive choices are important steps to protect women’s general and reproductive health, and as a result, improve the demographic situation.

Conclusion: In recent years, a large number of measures have been taken in the Russian Federation to reduce the number of induced abortions. Clinical guidelines and standards have been approved, and interactive educational modules on psychological pre-abortion counseling have been implemented. Speech modules for communicating with women in situations of reproductive choice have also been introduced into the work of medical organizations. Motivational surveys are conducted as part of a program to provide individual recommendations and support measures for women in such situations.

This review article analyzes the available data on the use of biological therapy in pregnant women with inflammatory bowel diseases (IBD). Special attention is given to the safety and efficacy of biological agents, as well as potential risks and complications.

Objective: To identify possible optimal therapeutic strategies based on current scientific evidence and clinical observations.

Materials and methods: For the study, a thorough search was carried out for both Russian and international scientific publications on the PubMed platform, including articles, reviews, and meta-analyses published up to 2024. The study is based on the current clinical guidelines of the Russian Federation, as well as international guidelines such as ECCO and NICE. Particular attention was paid to modern data and approaches related to the use of biological drugs in pregnant women with IBD.

Results: The treatment of IBD in pregnant women should be based on an integrated approach, including close collaboration of specialists from various fields, namely gastroenterologists, obstetricians-gynecologists, and colorectal surgeons. To date, the most commonly studied biological drugs used by pregnant women are TNF-α inhibitors. These drugs have a good safety profile for both the mother and the fetus. Vedolizumab and ustekinumab have a similar safety profile to anti-TNF drugs. However, their prescription should be discussed with the patient, taking into account the risks associated with discontinuation or continuation of therapy, as well as the possible impact on the course of pregnancy. Janus kinase inhibitors are the least studied biological drugs used during pregnancy. Due to the potential risks and lack of data, their use should be avoided during pregnancy and after childbirth, especially during breastfeeding.

Conclusion: Biologics are a proven and relatively safe method for maintaining remission, which increases the chances of successful pregnancy and minimizes the risk of complications. However, the safety issues for the fetus and the potential long-term consequences of using such medications remain poorly understood. This requires further research and close medical supervision.

Objective: To investigate the significant clinical and anamnestic predictors of fetal growth restriction (FGR) and develop effective predictive models using machine learning methods (MLM).

Materials and methods: This retrospective study included 620 pregnant women who were observed and delivered at the V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia. The study group comprised 300 patients with FGR, while the control group included 320 patients with healthy pregnancies. An analysis of the clinical and anamnestic data was conducted to build MLM models, including logistic regression and random forest.

Results: The logistic regression model identified the following predictors: age over 40 years, height less than 1.60 m, chronic arterial hypertension, smoking, a history of FGR, and threatened miscarriage in the first trimester with the formation of retrochorial hematoma and bleeding. This model predicts the development of FGR with a sensitivity of 73% and specificity of 80% (AUC 0.81). An alternative model constructed using random forest demonstrated an increased sensitivity of 78% and a decreased specificity of 74% (AUC 0.79). Within the random forest framework, the most significant contributors to the accuracy of the prognosis were age over 40 years, height less than 1.60 m, chronic arterial hypertension, a history of surgery resulting in a uterine scar, a history of FGR, and threatened miscarriage in the first trimester with retrochorial hematoma without bleeding.

Conclusion: Both models exhibited high predictive value for screening for FGR. Logistic regression offers interpretability, whereas random forest enhances the accuracy by accounting for nonlinear relationships. Implementing these models in clinical practice will optimize the monitoring of pregnant women at risk.

Objective: To determine the characteristics of surgical strategies and methods for intra- and postoperative hemostasis in patients undergoing relaparotomy following a cesarean section.

Materials and methods: A multicenter cross-sectional descriptive study was conducted to analyze the clinical and anamnestic data along with treatment outcomes of 97 cases of relaparotomy due to bleeding after cesarean section, which occurred in secondary- and tertiary-level maternity hospitals. Data were collected from six regions of the Russian Federation over three years, from January 1, 2022, to December 1, 2024: n = 20, n = 27, n = 14, n = 8, n = 18, and n = 10.

Results: During the analyzed three years (2022–2024), 44,792 cesarean sections were performed in institutions that reported relaparotomies. The need for surgical hemostasis during the initial operation emerged in 19/97 (19.6%) patients. Relaparotomy was performed in 97 patients, accounting for 0.22% of the total number of cesarean sections. Bleeding after cesarean section was most frequently noted at a gestational age of 37.0 (3) weeks. Relaparotomy was performed in 44 cases following planned operations, in 13 cases urgently, and in 40 cases emergently. Early postoperative bleeding (within 6 h), necessitating re-entry into the abdominal cavity, occurred in 69/97 (71.1%) parturient women. During relaparotomy, the uterus was removed as a source of bleeding in 21/97 (21.6%) cases. Ligation of the internal iliac arteries was performed in 19/97 (19.6%) patients, including five during hysterectomy and 14 while conserving the uterus. Three patients underwent repeated relaparotomy due to ongoing intra-abdominal bleeding. The mean total blood loss resulting from the two surgical interventions was 3,319 mL (1,960) ml. Blood transfusions were administered to 62 patients, of whom three received reinfusion in combination with donor erythrocytes. The mean blood transfusion volume was 1,261 (1,483) ml. The mean duration of stay in the intensive care unit was 65 (55) hours. Transfer to another institution was required in 25/97 (25.8%) postpartum women.

Conclusion: Bleeding most often occurred after planned surgery in pregnant women with uterine scars, indicating an insufficient assessment of risk factors and their prevention. Complex compression hemostasis is most frequently used to stop bleeding, which should be mastered by all surgeons performing cesarean sections.

Objective: To analyze the clinical characteristics, risk factors, and impact on lifestyle of women with uterine leiomyomas (ULs) and compare these findings with a control group of healthy women.

Materials and methods: Conducted from June 2023 to August 2024, the study included 1,000 Syrian women (500 patients with ULs and 500 controls) aged 22–83 from various cities. A questionnaire formed of 65 questions containing information about the clinical characteristics and risk factors for the development of uterine leiomyomas was used. Data was analyzed using Statistical Packages for Software Sciences (SPSS) version 30.

Results: Revealed significant differences between patients and controls in age at first menstruation (p = 0.046), length of the menstrual cycle (p = 0.016), duration of the menstrual bleeding (p = 0.043), age at menopause (p < 0.001), time elapsed since the last birth (p < 0.001), and endometrial ablation (p = 0.039). Regarding the characteristics of the Fibrous nodes, it indicated that submucosal fibroids were in only 6/500 (1.2%) women, while pedunculated was in 22/500 (4.4%) women, subserosal was in 227/500 (45.4%), and intramural was in 228/500 (45.6%).

Conclusion: This study demonstrated which clinical characteristics and risk factors for uterine leiomyomas were statistically significant in Syrian women. This may help determine the best techniques to diagnose and treat them well in order to prevent complications and reduce their impact on health-related quality of life.

Objective: To analyze and evaluate the nutritional status and nutritional components with potential pro-inflammatory and anti-inflammatory effects in the diet of patients with endometriosis, as well as to study the possible relationship between the nutritional status and intensity of pain syndrome.

Materials and methods: The study included 58 patients aged 19 to 44 years with various forms of endometriosis and pain syndrome. The pain syndrome was assessed using the visual analog scale (VAS) and numeric rating scale (NRS). The nutritional status was assessed by frequency analysis using a computer program developed by the Scientific Research Institute of Nutrition of the Russian Academy of Medical Sciences, 2003–2006 (version 1.2.4). Statistical data processing was performed using IBM SPSS Statistics 27.0.

Results: The comparison of the indicators with the recommended dietary allowance (RDA) of substances showed a deficiency in such important micronutrients as magnesium (Mg), calcium (Ca) (in groups with reduced BMI (rBMI) and high BMI (hBMI), iron, as well as vitamins B₁, B₂ and B₃. Insufficient intake of legumes and whole grains was associated with a lower intake of magnesium in the patients of the study groups. Its values were lower than the median RDA (420 mg/day), namely: 190.1 mg in patients with rBMI, p < 0.001 (RDA); 317.2 mg in patients with normal BMI (nBMI), 267.2 mg in patients with hBMI. Calcium intake was significantly decreased in women with rBMI and hBMI (610.8 mg and 798.2 mg, p < 0.05; RDA of calcium is 1000 mg/day). Excessive consumption of processed meat products (sausages) and semi-finished products led to an increase in the consumption of table salt in patients of all three groups, which naturally caused an increase in sodium intake. There were no significant differences in the intensity of pain syndrome among the patients according to NRS and VAS.

Conclusion: The revealed characteristics of the nutritional status of patients with endometriosis demonstrate the potential for the development of novel therapeutic approaches to pain management. Dietary correction can become a component of complex pain therapy in this category of patients and contribute to improving their quality of life.

Objective: To analyze the content of biomarkers of inflammation and angiogenesis in oral and peritoneal fluids in women with a common form of extragenital endometriosis including ovarian lesions.

Materials and methods: This was a comparative observational study. Group 1 (n=88) consisted of women with confirmed extragenital endometriosis including endometrioid ovarian cysts; group 2 (n=30) consisted of healthy women without signs of endometriosis. The samples of oral fluid (OF) were collected from all participants of the study, and samples of peritoneal fluid (PF) were collected from women of group 1. The levels of vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), and interleukins (IL), namely IL-1β, IL-6, IL-8, and IL-10 were studied in biological fluids.

Results: The level of VEGF in OF was significantly higher in the patients of group 1, namely 906.4 (281.9–178) pg/ml compared to the patients of group 2, 241.9 (105.225–324.475) pg/ml, p<0.001. The level of IL-8 was also significantly higher in group 1 compared to group 2, 100.85 (23.333–208.7) pg/ml versus 11.34 (6.549–21.205) pg/ml, respectively, p<0.001. The levels of TNF-α, IL-6, and IL-10 were higher in group 2. The analysis of the correlation between the levels of markers in OF and PF showed no correlation for IL-8, IL-10 and TNF-α and the presence of a very weak, nonlinear relationship for IL-1β, IL-6 and VEGF.

Conclusion: The data obtained suggest the independence of inflammatory and angiogenic biomarker profiles in different biological compartments. The results highlight the potential for future research into OF as a potential bio substrate that could indirectly reflect the characteristics of the systemic inflammatory response in patients with extragenital endometriosis.

Objective: To study clinical and anatomical features of patients with apical prolapse (AP).

Materials and methods: 230 medical records of patients with pelvic organ prolapse who underwent examination and treatment from 2019 to 2024 at the University Clinic "I am healthy!" were analyzed. The main patient group consisted of 130 women with apical prolapse, the comparison group included 100 patients with anterior/posterior vaginal wall prolapse without apical prolapse. Evaluation was performed according to the POP-Q classification, using standard questionnaires (POPDI-6, UDI-6) and clinical examination.

Results: Patients with apical prolapse more often reported incomplete bladder emptying and the need to reduce prolapse to ease voiding. In the comparison group, stress urinary incontinence and lower abdominal pressure were more common. In almost half of the patients with apical prolapse, the leading point was Ba (44.6%). In patients without apical prolapse, prolapse of the posterior vaginal wall (point Bp) occurred most often (62%). No significant differences in symptoms were found between the groups, which complicates the early diagnosis of apical prolapse.

Conclusion: When examining the patients with pelvic organ prolapse and collecting their history, it is necessary to take into account the "pitfalls" that complicate objective diagnosis of apical prolapse. It is necessary to improve the technique of physical examination of gynecological patients for early detection of first-level support defects, which will allow timely prescription of adequate treatment with the best long-term results.

Natural orifice transluminal endoscopic surgery (NOTES) is a new approach in various surgical disciplines. In this paper, we present our experience of using vaginal NOTES (vNOTES) for reconstructive surgery for apical prolapse.

Objective: To describe and illustrate transluminal bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES.

Materials and methods: The study included 73 women with stage III–IV pelvic organ prolapse, according to the POP-Q classification. Surgical treatment consisted of extirpation of the uterus followed by surgical correction of pelvic organ prolapse using various methods: transluminal endoscopic fixation of the vaginal stump to the uterosacral ligaments using the vNOTES technique (46 patients), McCall culdeplasty (27 patients). The study was conducted in the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University.

Results: The advantages of vNOTES compared to traditional vaginal surgery include reduced postoperative pain, improved cosmetic effect and reduced risk of intraoperative damage to the internal organs.

Conclusion: The technical result of using this operative technique is the surgical effectiveness of fixing the vaginal stump with suturing the uterosacral ligament at a distance of 45 mm parallel to the ischium. This distance is considered to be safe in terms of the trajectory of S1–S3 nerve roots.

The article analyzes modern pharmacotherapeutic approaches to the treatment of polycystic ovary syndrome (PCOS), which is one of the most common endocrine disorders among reproductive-aged women. The main statistical indicators of PCOS prevalence are given and the clinical manifestations of this disease are described. The application of combined oral contraceptives, antiandrogenic medications, and insulin sensitizers as first-line pharmacotherapeutic correction methods has been examined. The results of clinical studies confirming the effectiveness of these drugs are summarized and the need for further research to optimize therapy regimens is emphasized. The paper investigates the use of antiandrogens such as spironolactone and cyproterone acetate for correcting androgen-dependent manifestations of PCOS. Additionally, new approaches to PCOS therapy using glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, which have shown effectiveness in lowering glucose levels, are analyzed. The article emphasizes the significance of additional clinical studies to assess the long-term effects of combined therapy and improve treatment results for patients with PCOS. One of the main goals is to improve insulin sensitivity by using drugs like metformin, which helps to normalize metabolic parameters. Special attention is paid to the role of antiandrogens in correcting the symptoms of hyperandrogenism, namely hirsutism and acne; side effects and individual characteristics of patients are considered as well.

Conclusion: It is necessary to use a differentiated approach to treatment which can depend on the PCOS phenotype and the presence of concomitant metabolic disorders.

Endometriosis is a chronic condition characterized by severe pain, infertility, and reduced quality of life. This article presents the analysis of pharmacological and surgical treatments highlighted in systematic reviews and clinical studies. The efficacy of progestins, gonadotropin-releasing hormone (GnRH) agonists and antagonists, aromatase inhibitors, combined oral contraceptives, and other pharmacological agents is reviewed. The potential side effects, mechanisms of action of different drug groups and their effect on endometriotic lesions are discussed.

Particular attention is given to surgery including laparoscopic and laparotomic techniques and its impact on clinical and reproductive outcomes. The article presents the analysis of the advantages and limitations of surgical treatment including such parameters as remission duration and effects on ovarian reserve. The review provides the comparative analysis of treatment methods as well as the data on the recurrence rate, the need for adjuvant therapy and optimal management strategies for the patients with various types of the disease. The role of combination therapy that includes pharmacological treatment before and after surgery in reducing recurrence rate is considered. The article also examines the potential of emerging therapeutic strategies and highlights the need for further research to define optimal treatment regimens. The review demonstrated the importance of an individual approach and the integration of pharmacological and surgical methods for achieving the best therapeutic outcomes.

Conclusion: Pharmacological and surgical treatments for endometriosis have their benefits and limitations. Pharmacological treatment has been shown to be effective in relieving symptoms and reducing the risk of recurrence, but it comes with limitations in the duration of its use and side effects. Surgical treatment remains the standard for patients with advanced stages of the disease and infertility, since it provides significant improvements in reproductive and clinical outcomes. A combined approach, which includes pharmacological therapy before and after surgery, appears to be the most promising strategy.

Relevance: The article discusses the diagnosis and surgical treatment of a complex obstetric complication, namely vesico-uterine fistula after cesarean section (Youssef’s syndrome), with a minimally invasive access and modern medical technologies. Vesico-uterine fistula is usually a complication of surgical delivery or pathological delivery and it accounts for up to 9% of all urogynecological fistulas. The article presents the analysis of modern literature on genitourinary fistulas and a clinical observation of a vesico-uterine fistula in a 38-year-old patient.

Case report: The patient presented with hypomenorrhea and cyclic discharge of urine with blood during menstruation, periodic pain in the lower abdomen. In addition to standard visual diagnostic techniques, such as ultrasound and MRI, an office cystoscopy was performed to diagnose a fistula. The vesico-uterine fistula was sutured using laparoscopic access, with simultaneous metroplasty performed using fibrin glue. The long-term results of the operation were assessed after 4 months; the patient had no problems with urination; the thickness of the myometrium in the metroplasty area was 4 mm.

Conclusion: In order to prevent the development of a vesico-uterine fistula during cesarean section, it is necessary to perform the bladder mobilization. The vesico-uterine fistula should be sutured by a multidisciplinary surgical team with the participation of a urologist.